An analysis reinforces hospital and health system concerns about the likely impact of Medicare expansion as proposed by several lawmakers and candidates running in the 2020 Presidential election. Figure: exit rich text editor to add content The next Presidential election is over a year away, but it already is clear the idea of expanding the 60-million-person Medicare program will take center stage in the healthcare policy debate. As an alternative to Republican efforts to repeal and replace the Affordable Care Act (ACA), Democratic candidates have put forward various healthcare reform proposals that expand Medicare to various degrees. The proposals have different prospects for adoption, depending on the extent to which Democrats end up controlling both the Presidency and Congress. The crucial concern for the nation’s hospitals and health systems is the potential impact of Medicare expansion on their finances if some version of it were to be adopted. With